Abstract
The onset of bathing disability among older people is critical for a decline in functioning and has implications for both the individuals’ quality of life and societal costs. The aim of this study was to evaluate long-term cost effectiveness of an intervention targeting bathing disability among older people. For hypothetical cohorts of community-dwelling older people with bathing disability, transitions between states of dependency and death were modelled over 8 years including societal costs. A five-state Markov model based on states of dependency was used to evaluate Quality-adjusted life years (QALYs) and costs from a societal perspective. An intervention group was compared with a no intervention control group. The intervention focused on promoting safe and independent performance of bathing-related tasks. The intervention effect, based on previously published trials, was applied in the model as a 1.4 increased probability of recovery during the first year. Over the full follow-up period, the intervention resulted in QALY gains and reduced societal cost. After 8 years, the intervention resulted in 0.052 QALYs gained and reduced societal costs by €2410 per person. In comparison to the intervention cost, the intervention effect was a more important factor for the magnitude of QALY gains and long-term societal costs. The intervention cost had only minor impact on societal costs. The conclusion was that an intervention targeting bathing disability among older people presents a cost-effective use of resources and leads to both QALY gains and reduced societal costs over 8 years.
Highlights
IntroductionBathing disability is common among people older than 80 years (Jagger et al 2001; Naik et al 2004) and is associated with a high risk of disability in other activities of daily living (ADL) (Gill et al 2006b; Jagger et al 2001), the amount of informal and formal help (LaPlante et al 2002), admission to a nursing home (Gill et al 2006a) and death (Rozzini et al 2007)
The intervention led to a positive accumulation of Quality-adjusted life years (QALYs) as well as reduced societal costs from year 1 to 8, see Table 4
In terms of days in full health, the QALYs gains amounted to 19 days or 9 days
Summary
Bathing disability is common among people older than 80 years (Jagger et al 2001; Naik et al 2004) and is associated with a high risk of disability in other activities of daily living (ADL) (Gill et al 2006b; Jagger et al 2001), the amount of informal and formal help (LaPlante et al 2002), admission to a nursing home (Gill et al 2006a) and death (Rozzini et al 2007). The transition from being independent to becoming dependent on help from spouses, friends or the community in daily living is detrimental to quality of life (QoL) (Hellstrom et al 2004; Johannesen et al 2004) and has a significant impact on societal costs (Lindholm et al 2013)
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